Abstract

The advances in pharmacological and psychosocial treatments in the 1950s and 1960s facilitated the movement of care for increasing numbers of mentally ill people from the institutions to the community. This represented a radical change in mental health strategy and practice and has brought with it new sets of risks. Due to inherent stigmatisation and some well publicised cases of violence and murder, there is a perceived risk to the public from community-based mentally ill people. The findings of many studies have illustrated this and have led to the isolation and rejection of large numbers of people who have mental health problems. This has increased the risk to mentally ill people of victimisation and harassment from members of the public. Kelly and McKenna (1997) have shown that this takes many forms and occurs within and outside the home. Most worrying these latter risks can increase the former where some mentally ill people carry weapons to protect themselves. This in turn can increase public fear and raise stigmatisation. Furthermore, the lack of support and belonging can increase the risk of self-harm among the mentally ill. A more general risk is that for many deinstitutionalisation simply means transinstitutionalisation where incarceration in large mental hospitals is being replaced by incarceration within community based houses and flats. To assuage these risks mentally ill people still require social support and protection. The asylum the place may have disappeared but asylum the function is still required.